A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study

Abstract

BackgroundAtlantoaxial posterior pedicle screw fixation has been widely used for treatment of atlantoaxial instability (AAI). However, precise and safe insertion of atlantoaxial pedicle screws remains challenging. This study presents a modified drill guide template based on a previous template for atlantoaxial pedicle screw placement.Material/MethodsOur study included 54 patients (34 males and 20 females) with AAI. All the patients underwent posterior atlantoaxial pedicle screw fixation: 25 patients underwent surgery with the use of a modified drill guide template (template group) and 29 patients underwent surgery via the conventional method (conventional group). In the template group, a modified drill guide template was designed for each patient. The modified drill guide template and intraoperative fluoroscopy were used for surgery in the template group, while only intraoperative fluoroscopy was used in the conventional group.ResultsOf the 54 patients, 52 (96.3%) completed the follow-up for more than 12 months. The template group had significantly lower intraoperative fluoroscopy frequency (p<0.001) and higher accuracy of screw insertion (p=0.045) than the conventional group. There were no significant differences in surgical duration, intraoperative blood loss, or improvement of neurological function between the 2 groups (p>0.05).ConclusionsBased on the results of this study, it is feasible to use the modified drill guide template for atlantoaxial pedicle screw placement. Using the template can significantly lower the screw malposition rate and the frequency of intraoperative fluoroscopy.

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

“…Then, 4 animal studies and 4 cadaver specimen studies were excluded from the 21 studies that met the inclusion criteria. Finally, 13 eligible trials [14,[17][18][19][20][21][22][23][24][25][26][27][28] were included in this meta-analysis. The flow diagram for the literature selection is shown in Fig.…”

“…This may be the best choice because 3D printing technology and related imaging equipment can provide the spinal surgeon a three-dimensional model or imaging data of the patient's diseased spine [30,31]. There are different pedicle shapes, and 3D printing technology can produce many different drill guide templates that flexibly adjust the angle of the screw [7,20,32]. Though it improves the accuracy rate of the pedicle screw, the application of the technique is not more effective in reducing pain and disability after midterm follow-up in comparison with the free-hand technique [24].…”

“…As shown in Fig. 4, seven of the 13 studies [18,20,22,[25][26][27][28] reported operative time. Since the combined results indicated significant heterogeneity among studies (I 2 = 66.1%, P = 0.007), a random effects model was used to pool the results.…”

“…As shown in Fig. 5, five of the 13 studies [18,20,[26][27][28] reported intraoperative blood loss. A random effects model was used to summarize the results because the heterogeneity was significant among five studies (I 2 = 86.1%, P = 0.000).…”

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

“…Grade 0 is considered the accuracy of in C2 screw placement [28]. [17,28,29,50,52,56,59,63,67,68,75,82,84,87] Laine et al [89] 2000 Based on CT images, in this classification, screw position was staged as screw inside the pedicle or perforation of the pedicle cortex by up to 2 mm, from 2 to 4 mm, from 4 to 6 mm, or by more than 6 mm. Type I and type II were categorized as acceptable placement.…”